Provider Demographics
NPI:1235382219
Name:NAKAMURA, NICOLE KANANI MASUKAWA (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:KANANI MASUKAWA
Last Name:NAKAMURA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:KANANI
Other - Last Name:MASUKAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3511 MAUNALOA AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2254
Mailing Address - Country:US
Mailing Address - Phone:808-277-8797
Mailing Address - Fax:
Practice Address - Street 1:3511 MAUNALOA AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2254
Practice Address - Country:US
Practice Address - Phone:808-277-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1507103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000OtherUPIN